Annual Wellness Visit (AWV) - JF Part B

HCPCS/CPT Codes

• G0438 - Initial visit
• G0439 - Subsequent visit

Frequency

• G0438 - Once in a lifetime
• G0439 - Annually

Coverage

• Beneficiary not within 12 months after effective date of their first Medicare Part B coverage period
• Has not received Initial Preventive Physical Examination (IPPE) or AWV within past 12 months
• Performed by health professional:
  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Medical professional (including health educator, registered dietitian, nutrition professional or other licensed practitioner) or team of such medical professionals, working under direct supervision of physician

No specific diagnosis code required; bill using the most appropriate diagnosis

Payment

Copayment/coinsurance waived; Deductible waived

Noridian Medicare Portal

Yes - G0438 and G0439

Resources

• IPPE and AWV
• Annual Wellness Visit Educational Tool
• CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 280.5
• CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 18, Section 140
• CMS Medicare Learning Network (MLN) Matters Special Edition (SE) 18004 - Review of Opioid Use During the IPPE and the AWV
• CMS Medicare Preventive Services
• Code of Federal Regulation 42 CFR 410.15(a)